HIV PREVENTION
Since the onset of HIV/AIDS in the early 1980s, gay and bisexual men have been vastly overrepresented among those infected with HIV in the modern Western world. Subsequently, in the US and Canada, gay/bisexual/MSM have been a focal point of public health outreach and service work. But while keeping gay and bisexual men “safe” from infection has been a unifying goal of prevention work and organization, the history of gay/bisexual/MSM HIV prevention in the US is both complex and contentious, representing more a shifting arena of competing knowledge claims and jurisdictional struggles than a singular, internally aligned health prevention movement. In fact, over the past 30 years, since the discovery of the virus that causes AIDS, HIV prevention work has been the site of charged paradigmatic contests over how “MSM” are imagined as subjects of health directives, how to best manage, inform and govern sexual conduct, the role of sexual pleasure in prevention discourse, the proper goals of HIV prevention, the role of scientific expertise, and the management of evolving scientific knowledge about disease transmission and its relationship to prevention directives.
My study, funded by a five-year Standard Operating Grant from the Canadian Institute of Health Research (CIHR), draws upon original fieldwork in Toronto and Los Angeles—two North American cities with significant rates of HIV infection among gay and bisexual men and elaborate prevention and outreach infrastructures that developed early on in the epidemic. Through interview and archival research on the organizational and governmental response to the HIV epidemic, I develop a comparative sociological account of gay/bisexual/MSM HIV prevention across the two countries and over three decades of public health intervention. In the US, much more than simply a biomedical response to the epidemic, HIV prevention has developed in a contested field of competing positions as actors from front-line workers to top officials at the Centers of Disease Control vie for epistemic authority and seek to end the epidemic in a manner commensurate with their particular professional and disciplinary dispositions and interests. In Toronto, Canada, by contrast, the prevention arena has developed around an ethos of collective responsibility and a democratized culture of power sharing whereby expertise is conceived to exist in local, indigenous and community based contexts.
Concepts & Questions: This study draws from a broad science and technology literature to make sense of the prevention enterprise. From this sociological vantage point, I am less concerned with the successes and failures of prevention itself, than with the making of prevention science and the execution of HIV MSM-focused behavioral interventions on the ground. Focusing on the institutional contexts in which HIV prevention is developed, the study advances four central questions:
1) How have gay/bisexual MSM HIV prevention programs executed prevention services over time and what has been their relationship to each other and to the state?
2) What expert epidemiological, social scientific and local folk knowledges regarding the sexual actor have emerged over the past 30 years, how have they been adjudicated and how have they been translated to prevention work?
3) What impact have external stakeholders, including federal and provincial funders and non-state actors such as the media and ethnic based community leaders, had on the form and substance of prevention work?
4) How has the target gay/bisexual/MSM subject been constructed in discourse and with what effects for prevention praxis?
Through a systematic, multi-method examination of the organizational and institutional contexts that underpin the HIV prevention industry, I show how HIV prevention materializes less as a "pure science" than a social product forged in the relations of actors and entities with vastly uneven access to resources and credibility. This is by no means to propose a cynical view of the motivations of prevention actors but, instead, to show the inextricability of disciplinary dispositions gained through scholarly and professional training, professional and organizational interests, and the political economy of the HIV prevention arena.
Beyond the arena of HIV prevention, I also hope to shed light on disease-prevention movements more broadly, as these take form against a backdrop of changing, often contested expert, epidemiological and sociocultural knowledges and practices. In fact, in light of the growing medicalization of every day life, it is likely that HIV prevention is not unique in its complexity nor in its contentious political character. From heart disease and diabetes to obesity, autism and breast cancer, prevention efforts often represent a composite of actors with a variety of institutional affiliations and disciplinary dispositions, united around similar goals but with competing visions of the “what, who, how and why” of their respective causes. Such competing visions bear not only on disease treatment, but also on the most fundamental elements of prevention research and intervention practice.
My study, funded by a five-year Standard Operating Grant from the Canadian Institute of Health Research (CIHR), draws upon original fieldwork in Toronto and Los Angeles—two North American cities with significant rates of HIV infection among gay and bisexual men and elaborate prevention and outreach infrastructures that developed early on in the epidemic. Through interview and archival research on the organizational and governmental response to the HIV epidemic, I develop a comparative sociological account of gay/bisexual/MSM HIV prevention across the two countries and over three decades of public health intervention. In the US, much more than simply a biomedical response to the epidemic, HIV prevention has developed in a contested field of competing positions as actors from front-line workers to top officials at the Centers of Disease Control vie for epistemic authority and seek to end the epidemic in a manner commensurate with their particular professional and disciplinary dispositions and interests. In Toronto, Canada, by contrast, the prevention arena has developed around an ethos of collective responsibility and a democratized culture of power sharing whereby expertise is conceived to exist in local, indigenous and community based contexts.
Concepts & Questions: This study draws from a broad science and technology literature to make sense of the prevention enterprise. From this sociological vantage point, I am less concerned with the successes and failures of prevention itself, than with the making of prevention science and the execution of HIV MSM-focused behavioral interventions on the ground. Focusing on the institutional contexts in which HIV prevention is developed, the study advances four central questions:
1) How have gay/bisexual MSM HIV prevention programs executed prevention services over time and what has been their relationship to each other and to the state?
2) What expert epidemiological, social scientific and local folk knowledges regarding the sexual actor have emerged over the past 30 years, how have they been adjudicated and how have they been translated to prevention work?
3) What impact have external stakeholders, including federal and provincial funders and non-state actors such as the media and ethnic based community leaders, had on the form and substance of prevention work?
4) How has the target gay/bisexual/MSM subject been constructed in discourse and with what effects for prevention praxis?
Through a systematic, multi-method examination of the organizational and institutional contexts that underpin the HIV prevention industry, I show how HIV prevention materializes less as a "pure science" than a social product forged in the relations of actors and entities with vastly uneven access to resources and credibility. This is by no means to propose a cynical view of the motivations of prevention actors but, instead, to show the inextricability of disciplinary dispositions gained through scholarly and professional training, professional and organizational interests, and the political economy of the HIV prevention arena.
Beyond the arena of HIV prevention, I also hope to shed light on disease-prevention movements more broadly, as these take form against a backdrop of changing, often contested expert, epidemiological and sociocultural knowledges and practices. In fact, in light of the growing medicalization of every day life, it is likely that HIV prevention is not unique in its complexity nor in its contentious political character. From heart disease and diabetes to obesity, autism and breast cancer, prevention efforts often represent a composite of actors with a variety of institutional affiliations and disciplinary dispositions, united around similar goals but with competing visions of the “what, who, how and why” of their respective causes. Such competing visions bear not only on disease treatment, but also on the most fundamental elements of prevention research and intervention practice.
